title: Objective measurement of limb perfusion by dermal fluorometry. A criterion for healing of below-knee amputation.
abstract: Quantitative fluorometry has been recommended as an accurate adjunct to clinical judgment in the preoperative assessment of lower-extremity amputation level. In this prospective study of 56 patients who had below-knee amputation, clinical judgment was used as the sole criterion for site selection. Quantitative fluorometry was compared with clinical judgment in a prospective, blinded study. All patients were studied before amputation with administration of intravenous fluorescein. Fifteen minutes after injection, objective measurement of dye fluorescence was performed at multiple sites with a quantitative fluorometer, and a dye fluorescence index was derived. All limbs undergoing amputation were ischemic, manifested by rest pain, nonhealing ulcers, or gangrene. Five patients (8.7%) failed to heal at the below-knee level. The mean dye fluorescence index for the group that healed was 81 +/- 51 (range, 13 to 259) and for the group that failed to heal, 110 +/- 49 (range, 70 to 195). Objective measurement of fluorescein perfusion did not correlate with amputation healing at the below-knee level in our patient population.
authors.affiliation: Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill.
authors.forename: S J
authors.initials: SJ
authors.lastname: Burnham
authors.forename: W H
authors.initials: WH
authors.lastname: Wagner
authors.forename: B A
authors.initials: BA
authors.lastname: Keagy
authors.forename: G
authors.initials: G
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005260:Female; D005452:Fluoresceins; D005470:Fluorometry / Q000379:methods; D006801:Humans; D007717:Knee / Q000601:surgery*; D007866:Leg / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D016037:Single-Blind Method; D012867:Skin / Q000098:blood supply*; D014945:Wound Healing
chemical_list: D005452:Fluoresceins